The risk factors of ketoacidosis in children with newly diagnosed type 1 diabetes mellitus

Background and aims: Diabetic ketoacidosis (DKA) is still a severe complication associated with significant morbidity and mortality. The aim of this study was to determine the predictors of DKA in children with newly diagnosed type 1 diabetes mellitus (T1DM). Material and methods: The study group consisted of new-onset type 1 diabetic patients admitted to our hospital between January 2006 and March 2008. One hundred and eighty-seven children were identified (95 females and 92 males) and their mean age was 8.9 +/- 4.6 yr (0.8-17.8). Hemoglobin A1c, blood gases, and fasting c-peptide level were evaluated in all children. DKA was defined as a capillary pH < 7.3 and blood glucose > 11 mmol/L. Results: At the time of T1DM diagnosis, 26% of children had DKA. Misdiagnosis was significantly associated with the incidence of DKA. In the group with DKA, c-peptide level was significantly lower than in the group without DKA (p = 0.003.) The most prone to DKA were children under 2 yr of age (n = 14). In this age group, DKA was present in 71% of individuals and the lowest c-peptide level was observed compared to older children (p < 0.0001). There was significant correlation between the c-peptide level and age of children (r = 0.41, p < 0.0001). Conclusions: The incidence of DKA among newly diagnosed patients with T1DM remains unacceptably high and indicates greater necessity of medical alertness for this diagnosis, especially in the youngest children. Children under 2 yr of age remain the most prone to DKA, which may be related to delay in diagnosis and more aggressive beta-cell destruction.